Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Patient compliance with drug therapy for diabetic nephropathy

Dyfrig Hughes and Braden Manns
CMAJ May 30, 2000 162 (11) 1553;
Dyfrig Hughes
Prescribing Research Group University of Liverpool Liverpool, UK Internist Calgary, Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Braden Manns
Prescribing Research Group University of Liverpool Liverpool, UK Internist Calgary, Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

William Clark and colleagues were clearly sensitive to the effects of patient compliance in their study of the cost-effectiveness of angiotensin- converting-enzyme (ACE) inhibitor therapy for diabetic nephropathy.1 This highlights 3 important assumptions regarding compliance that require further clarification.

First, it was assumed that noncompliers lose renal function at the same rate as patients in the placebo arm of a diabetic nephropathy trial comparing the effects of ACE inhibitors and placebo.2 It would seem unlikely that patients taking up to 80% of their ACE inhibitor (the definition Clark and colleagues offered for noncompliance) would lose renal function at the same rate as those taking none. The rate at which noncompliers lose renal function should have been subjected to sensitivity analysis.

Second, the authors based their analysis on the results of a patient- interview study3 in which 34% of patients stated cost as the primary barrier to compliance. To suggest that 34% of patients would be noncompliant for this reason is a major assumption. A recent observational study of persistence with antihypertensive therapy suggested that the relationship between drug cost and compliance was less clear.4 The more expensive ACE inhibitors were in fact associated with higher persistence rates. Thus, when one is evaluating the implications of noncompliance, factors other than drug costs must not be ignored.

Finally, provincial drug coverage may not have had as much impact as assumed because a proportion of patients already have the cost of their medications covered through private insurance. Before ACE inhibitor coverage becomes standard practice, we propose that the effect on compliance of providing medications free at the point of delivery should be more thoroughly assessed. If such studies confirm that compliance improves significantly, then consideration could, in fact, be given to developing a national pharmacare program, whereby cost-effective medications, such as ACE inhibitors for diabetic nephropathy, would be provided free to all Canadians.

Competing interests: None declared.

References

  1. 1.↵
    Clark WF, Churchill DN, Forwell L, Macdonald G, Foster S. To pay or not to pay? A decision and cost-utility analysis of angiotensin- converting-enzyme inhibitor therapy for diabetic nephropathy. CMAJ 2000;162(2):195-8.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    Lewis EJ, Hunsicker LG, Bain RP, Rohde RD, for the Collaborative Study Group. The effect of angiotensin-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993;329:1456-62.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Brand FN, Smith RT, Brand PA. Effect of economic barriers to medical care on patients' noncompliance. Public Health Rep 1977;92:72-8.
    OpenUrlPubMed
  4. 4.↵
    Caro JJ, Speckman JL, Salas M, Raggio G, Jackson JD. Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data. CMAJ 1999; 160(1):41-6.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

CMAJ
Vol. 162, Issue 11
30 May 2000
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Patient compliance with drug therapy for diabetic nephropathy
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Patient compliance with drug therapy for diabetic nephropathy
Dyfrig Hughes, Braden Manns
CMAJ May 2000, 162 (11) 1553;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Patient compliance with drug therapy for diabetic nephropathy
Dyfrig Hughes, Braden Manns
CMAJ May 2000, 162 (11) 1553;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Moving surgical care out of hospitals to reduce wait times
  • Coexisting failures do not diminish the stature of a giant
  • Dare we hope
Show more Letters

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire